- Commonwealth Care Alliance (Boston, MA)
- …Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day ... timely clinical and service authorization review for medical necessity and decision-making. The ...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on managed care and Medicaid policies and procedures… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays...vital role in ensuring the delivery of high-quality, evidence-based care . This position is responsible for reviewing and evaluating… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. + Document review … more
- Molina Healthcare (Salt Lake City, UT)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : Ambulatory Care Services (Ravitz Cancer Center Research Unit (CCRU) ) Apply Now **Mission Statement** The University of Michigan Health ... employment opportunity employer. **Job Detail** **Job Opening ID** 271277 **Working Title** REGISTERED NURSE : Ambulatory Care Services (Ravitz Cancer Center… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE - Brighton Center for Specialty Care - Operating Room Apply Now **Mission Statement** Michigan Medicine improves the health of patients, ... including pediatric and adult populations + Perform advanced case review and collaborate care for Spine Surgical...**Job Opening ID** 271037 **Working Title** REGISTERED NURSE - Brighton Center for Specialty Care -… more
- University of Michigan (Ann Arbor, MI)
- …**Job Detail** **Job Opening ID** 271029 **Working Title** REGISTERED NURSE (Cardiovascular Center- CVC 5, Cardiovascular Intensive Care Unit) **Job ... REGISTERED NURSE (Cardiovascular Center- CVC 5,...to deliver the safest and highest quality of health care . Applicants are expected to review the… more
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